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52]

Original Article

Comparison of the Effectiveness of Video‑ assisted Teaching Program

and Traditional Demonstration on Nursing Students Learning Skills of
Performing Obstetrical Palpation

Abstract Barkha Devi1,

Background: Teaching methods have failed to keep up with the pace of the changing curriculum. Bidita Khandelwal2,
Clinical practice, an essential part of nursing education, links theory with practice, particularly Mridula Das3
in midwifery nursing. Thus, this study aimed to compare the effects of video‑assisted teachingprograms 1
Department of Nursing,
and traditional demonstration on nursing students learning obstetrical palpation skills. Materials and
Sikkim Manipal university,
Methods: This is a quasi‑experimental research work with pretest, posttest, controlgroup design in which Gangtok, Sikkim, India,
60 third‑year students of Bachelor of Science in Nursing were selected and assigned randomly, by 2
Department of Medicine,
lottery method, into an experimental group (video‑assisted teaching program) and a control group Sikkim Manipal Institute
(traditional demonstration) regarding obstetrical palpation. The data were collected through a of Medical Sciences,
self‑designed rating scale. The validity of the rating scale was established by a panel of seven Gangtok, Sikkim, India,
3
experts from the field of obstetrical and gynecological nursing, and the reliability was established Department of Nursing,
through Cronbach’s (0.78), which showed the tool was consistent among the population. Results: Sikkim Manipal college of
Nursing, Gangtok, Sikkim, India
The results showed a significant difference between the pretest and posttest skill scores of students
who were exposed to video‑assisted teaching program and traditional demonstration (t = 18.35, p <
0.001). Although both the methods were equally effective in enhancing skill, traditional demonstration
scored much better than the video‑assisted teaching program when the posttest skills were compared (t
= 36.40, p = 0.001). Conclusions: The routine educational method, i.e., demonstration, is more
effective in developing skills emphasizing the reinforcement of academicians in enhancing
teaching skills by adopting blended teaching technique for enhancing memory storage, retrieval,
cognition, and learning.

Keywords: Clinical competence, nursing, palpation, students, video–audio media

Introduction nursing education, and training. Therefore,

the researcher felt a gap in the literature
In the last few decades, nursing education
on pedagogy tailored to the peculiar needs
in India has undergone tremendous change,
of the teaching–learning process for nurses
from informal bedside hospital‑basedtraining
and nursing students among developing
to university‑based graduate, postgraduate, and
countries, in particular, India.[1,2]
doctoral nursing education. Furthermore, the
rapid growth and development in science Teaching is distinctively a human activity.
and technology have largely influenced the Systematic attention to methods and
need for improved methods of teaching– materials of teaching and learning as
learning process to nurses in India. Nurses well as mastery of the subject matter are Address for correspondence:
are actively involved in teaching patients, essential for the development of artistic Dr. Barkha Devi,
Sikkim Manipal College of
families, and communities as well as teaching.[1] The nursing curriculum
Nursing, Sikkim Manipal
educating and training the new nurses. India includes various subjects to be taught in University, Gangtok, Sikkim,
has observed rapid growth and development each year of the course. Obstetrical and India.
in nursing education, resulting in an midwifery nursing is one of the third‑year E‑mail: barkhadevi2@gmail.com
increased sense of responsibility among subjects. The effective management of
Indian nursing faculty to educate future the antepartum and intrapartum periods is
Access this article online
nurses using educational technology so that completely dependent on the accuracy of
they efficiently handle patient teaching, obstetrical assessment, including assessment Website: www.ijnmrjournal.net
of women’s abdomen for fetal presentation, DOI: 10.4103/ijnmr.IJNMR_35_18
This is an open access journal, and articles Quick Response Code:
are distributed under the terms of the Creative How to cite this article: Devi B, Khandelwal B, Das M.
Commons Attribution‑ NonCommercial‑ ShareAlike
Comparison of the effectiveness of video-assisted
4.0 License, which allows others to remix, tweak,
teaching program and traditional demonstration
and build upon the work non‑ commercially, as
long as appropriate credit is given and the new
on nursing students learning skills of performing
creations are licensed under the identical terms. obstetrical palpation. Indian J Neonatal Med Res
2019;24:118-23.
For reprints contact: reprints@medknow.com Received: February, 2018. Accepted: October, 2018.

118 © 2019 Iranian Journal of Nursing and Midwifery Research | Published by Wolters Kluwer - Medknow
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Devi, et al.: Video‑ assisted teaching program and traditional demonstration on performing obstetrical palpation

position, and wellbeing, which in turn helps in making the experimental group (n = 20) evaluated their Foley’s
early decisions regarding the place and mode of delivery.[2] catheterization performance by reviewing video recordings,
whereas students in the control group (n = 20) received
The nursing curriculum is continuously changing. Teaching
written evaluation guidelines only. The results showed that
methods have failed to keep up with the changing
the students in the experimental group had better scores on
curriculum.[3] Bandura stated that the style of teaching
competency (p < 0.001), communication skills (p < 0.001),
preferred by a student is a reflection of his or her learning
and learning motivation (p = 0.018) than the control
style.[4,5] The teaching of different skills requires various
group at the posttest, which was conducted 8 weeks
techniques and contemporary methods along with the
traditional lecture method. Video‑based education can be a after the pretest. The inference of the study indicates
suitable substitution when the demonstration method is that self‑awareness of one’s performance developed by
unavailable.[6] One of the advantages of video‑based reviewing a videotape appears to increase the competency
education is that the voice of the broadcaster can be heard. of clinical skills among nursing students.[9]
Moreover, the figures, movements, illustrations used, and Several methods can be used to identify fetal position,
demonstrations presented can be seen. presentation, attitude, engagement, and wellbeing.
According to Doijad and Kamble, animals were sacrificed Methods such as ultrasonography, vaginal examination,
regularly to show experimental physiology practical to and abdominal palpation can be used to identify position,
first‑year medical students. However, owing to certain ethical presentation, attitude engagement, and wellbeing of fetus
issues, ecosystem imbalance, and animal rights activists, inside the mother’s uterus.[10] However, ultrasonography
there is a scarcity of animals for experimental use. Hence, is not cost‑effective as the equipment is costly and its use
they emphasized the need to introduce a new effective requires expertise.[11] Vaginal examination, on the contrary,
alternative teaching method to replace these animal is only reliable when women are in established labor
experiments. In their study, they planned to find the better because its accuracy depends on dilatation and effacement
of two methods, video demonstration and live of the cervix along with descent of the fetus presenting
experimentation, on a small group (40 students) of first‑year part.[9] This emphasizes the need for accurate obstetrical
medical students. The students were taught experimental palpation that can be performed by the student nurses or
physiology by both the methods. The outcome was assessed registered nurses. It is noninvasive and does not require
in two ways, by comparing students’ performance in a any equipment and can be performed by a trained nurse at
self‑assessment question test with their perception toward the any time of the day, establishing its popularity as the most
two methods by using the Likert scale. The result showed feasible test of fetal wellbeing.[12,13]
that the knowledge gained by both the methods was the The importance of obstetrical palpation in antenatal
same, but the perception of students toward video assessment is a globally acclaimed fact. As stated by
demonstration was better than that of live experimentation. Crede and Leopald in 1982, the four maneuver techniques
Thus, the study concluded that students’ response toward in obstetrical palpation ensure identification of the fetal
video demonstration as a novel teaching–learning presentation, lie, attitude, position of different parts of the
method was excellent, and video demonstration can be body, and wellbeing. Mak and Wong conducted a study
a useful alternative to live experimentation for teaching and found that midwives had a favorable attitude toward
experimental physiology to first‑year medical students.[7] obstetrical palpation but their confidence to practice was
One of the most important principles in education is inadequate.[12]
adopting a teaching method in concordance with objectives, Grant et al. evaluated the effect of videotape‑facilitated human patient
contents, and learners. Teaching and learning clinical simulator (HPS) practice and guidance on clinical
skills are challenging aspects of education in the field of performance indicators among student nurses and
medicine and the allied health professions. Some of the anesthetists. The treatment group (n = 20) participated in
new researchers have shown that video‑based instruction has HPS practice and guidance using videotape‑facilitated
many advantages in comparison with other methods. But debriefing, and the control group (n = 20) participated in
in the domain of the psychomotor learning, there is not HPS practice and guidance using oral debriefing alone. The
enough evidence to show that video‑based instruction is an result showed that students in the intervention group were
effective teaching method.[8] significantly more likely to demonstrate desirable behaviors
Yoo et al. (2010) conducted an experimental study on the concerning patient identification, team communication,
effect of the video recording of Foley’s catheterization and vital signs. The role performed by the students in the
to evaluate its effect on three outcomes: measures of simulation significantly impacted their performance.
the competency of procedure, communication skills, When scores of both the intervention and control groups
and learning motivation. The study was conducted were combined, team leaders, airway managers, and nurse
through self‑evaluation using a video recording of the Foley’s anesthetists had higher mean total performance scores
catheterization of the students. The students in than crash cart managers, recorders, or medication nurses.

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Devi, et al.: Video‑ assisted teaching program and traditional demonstration on performing obstetrical palpation

Thus video‑facilitated simulation feedback is potentially a midwifery subject in the third year. These students have
useful tool in increasing desirable clinical behaviors in a never been exposed to this subject before. Thus, for them,
simulated environment.[13] obstetrical palpation is a very new skill to learn. At first,
all the nursing skills and procedures are demonstrated in a
In the pressured environment of a classroom, if tools are
structured and well‑equipped laboratory. Once the student is
not intuitive and simplified for the educator and student,
competent enough to perform the skill, they are posted to
they won’t be used. However, the right technology will be
the clinical area. The sample included 60 nursing students
quickly adopted by all. Every educator knows that delivery
who were currently enrolled in the fresh third‑year B.Sc. in
in a stimulating fashion, including visual input, can be
nursing program. The duration of the study was 3 months.
key to learning in terms of understanding, application, and
retention.[14,15] Some of the concepts were defined in the study. Skill was
defined as the ability to perform obstetrical palpation,
The use of video in nursing education classes provides an
which includes the abdominal examination as measured by
easy, innovative, and user‑friendly way to engage today’s
structured rating scale to have achieved the desired effect
nursing students. Video presentations can be easily adapted
as evident from gain‑in‑skill scores. Obstetrical palpationrefers to
into nursing courses at any level, whether a fundamental
antenatal examination of a pregnant woman that consists of
course for undergraduate students or a theoretical
the following components: Palpation‑fundalpalpation—determines
foundations course for graduate students. Increasingly,
the presence of head or buttocks of the fetus; lateral
nursing students enter nursing programs experienced in
palpation—determines the fetal back in order to determine
the latest communication technologies and knowledgeable
position; pelvic‑palpation‑pelvic grip1—determines the pole of
about various media offerings. Today, it is expected
the fetus; pelvic grip 2 (Pawlik’s maneuver)—determines
that nurse educators should use creative communication
the engagement of fetal head;[16] and auscultation—a Pinards
technologies to enrich the learning environment. Clinical
fetal stethoscope is used to hear the fetal heart sound.
practice is an essential part of nursing education which
links theory with practice. Obstetrical palpation is one of The sample size (n = 60) was calculated using the formula
the areas of clinical practice which demands accuracy and for comparing averages, 95% safety factor, and statistical
expertise that improve with the length of experience. [13,16,17] power of 80%. Among the 110 third‑year B.Sc. nursingstudents,
As today’s student nurses are tomorrow’s professional 60 students were randomly selected and assigned into
nurses who can contribute more in the field of treatment, experimental (n = 30) and control (n = 30) groups,
educating these students and creating awareness, helping respectively, through random allocation (drawing lottery).
them to learn more about obstetrical palpation, will bring Two clinical teachers were selected randomly from the
about positive outcomes in the future health indicators same college to select and assign the students to different
and quality of care. According to the famous saying, right groups to maintain the objectivity and homogeneity of the
practice is the safest investment toward hazard‑free care,and study.
right practice comes from right education.[15,16]
The inclusion criteria were students who were available
at the time of data collection, willing to participate, and
Materials and Methods
who had not been exposed to any classes or demonstration
The study was quasi‑experimental in design conductedwith on obstetrical palpation. The exclusion criteria of the
the objectives of assessing the effectiveness of study consisted of nursing students who were repeaters
video‑assisted teaching program and traditonal demonstration on in the same class. The nursing students learning skill
obstetrical palpation among nursing students in was evaluated by a structured rating scale on obstetrical
experimental and control groups, to compare the palpation. The scale was given to five experts from
effectiveness in terms of gain‑in‑skill scores in bothgroups and obstetrics and gynecological nursing and community health
to find out the association between the pretest skill scores nursing. The experts were chosen based on their clinical
with selected variables. experience, expertise, and interest in the problem area. The
reliability of the structured rating scale was tested using the
In 2016, this study was conducted in the College of
inter‑rater method by two raters. In the end, it ensured thatthe
Nursing at Sikkim through quasi‑experimental approach with
instrument used for measuring experimental variables gives
pretest, posttest, nonequivalent control group design in two
the same results every time, hence showing the coefficient
phases. In the first phase, the video‑assisted teaching program
of equivalence among the test items.
was developed and research tools were prepared and tested
for reliability and validity. In the second phase, the The scale was divided into preparatory phase (eight items),
video‑assisted teaching program and traditonal demonstration abdominal palpation—fundal palpation (four items), lateral
were implemented concerning the provided rating scale. palpation (four items), first pelvic grip (eight items),
Also, the effects on the dependent variable of the study were second pelvic grip (six items), auscultation for fetal heart
reviewed. The Bachelor of Science (B.Sc.) in nursing sound (three items), and termination phase (four items).
program is a 4‑year course with the obstetric and

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Devi, et al.: Video‑ assisted teaching program and traditional demonstration on performing obstetrical palpation

Each item in the scale is scored on a three‑point rating data, paired t‑test, independent t‑test, and Chi‑square testwere
scale with the scoring criteria of Perform (2), Somewhat used. The statistical package used for data analysis and
perform (1), and Not perform (0) and a total score of 78. interpretation was IBM SPSS Statistics for windows,
version 25.0 (IBM Corp., Armonk, New York).
After completing the background data form, before starting the
intervention, the pretest skill of the students from both groups Ethical Considerations
was assessed in maternal and child health nursing laboratory
This study was approved by the SMIMS Institutional
for one day by the researcher and one clinical instructor who
Ethics Committee (IEC) of the university with registration
completed the training session for obstetrical palpation. Each
no.: IEC/419/16‑02 dated May 3, 2016. All enrolledstudents
student from the group was asked to perform the obstetrical
signed an informed consent containing the clear data about
palpation and at the same time, the competency was assessed
the study, its purpose, and methods.
through the rating scale. The pretest/posttest design was
selected because, in this college, students are frequently Results
posted to OBG department for basic care in their first year of
the nursing course. Hence to maintain the homogeneity, the Data analysis showed that the students in the traditional
pretest was performed among these students. demonstration and video‑assisted teaching program had
identical variables such as age, type of residence, family
Subsequently, only a traditional demonstration on obstetrical income, previous academic performance, and previous
palpation was conducted for students in the comparison experience in taking care of antenatal mother (p > 0.05)
group (n = 30) for 30 min in the maternal and child [Table 1].
health nursing laboratory. The traditional demonstration
is a routine teaching method adopted by nursing colleges Thus, based on the paired t‑test result, there was a
for teaching any skill. Here, teaching of correct steps of statistically significant difference within the group. This
obstetrical palpation on a pregnant simulator and adequate indicates that both the methods were found equally
explanation by the investigator were adopted. Whereas effective in enhancing the skill of nursing students in
the selected video‑assisted teaching program for the performing obstetrical palpation (t = 3.66, p < 0.001).
experimental group (n = 30) was a prerecorded 22‑minlong Moreover, based on independent t‑test results, there was no
video clip on steps of obstetrical palpation prepared by the significant difference between the two groups in terms of
investigator. The clip was shown using a laptop and overall mean pretest skill score (t = 0.41, p > 0.05) on
speakers in a classroom setting on the same day. obstetrical palpation before the intervention. This lack of
difference was due to the random assignment of students in
After the intervention, the posttest observation and
the two groups [Table 2].
assessment in both groups were done on the 8 th day in the
maternal and child health nursing laboratory where each However, the results [Tables 2 and 3] also showed that
student performed the skill for 10–15 min. For analyzing the overall mean posttest skill score of the nursing

Table 1: Comparison of sociodemographic characteristics between experimental and control groups

Groups Control group Experimental group
Traditional demonstration Video‑assisted teaching program
Variables n (%) Chi‑square n (%) Chi‑square p
Age (in years) 1.51 0.18 3.84, >0.05
18‑20 years 17 (57) 18 (60)
21‑23 years 13 (43) 12 (40)
Place of residence 0.69 0.43 5.99, >0.05
Nursing hostel 18 (60) 17 (56)
Paying guest 1 (3) 2 (7)
Rented/own house 11 (37) 11 (37)
Family income 1.51 0.07 3.84, >0.05
Rs. <30,000/month 18 (60) 17 (57)
Rs. ≥30,000/month 12 (40) 13 (43)
Previous academic performance 0.84 3.07 5.99, >0.05
Not clear all subjects 5 (16) 5 (16)
<50% 3 (10) 4 (13)
>50‑75% 22 (74) 21 (70)
Previous experience in taking care of antenatal mother 1.26 0.53 3.84, >0.05
Yes 16 (53) 12 (40)
No 14 (47) 18 (60)

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Devi, et al.: Video‑ assisted teaching program and traditional demonstration on performing obstetrical palpation

students on obstetrical palpation was higher in the significant increase in posttest skill. As already mentioned,
traditional demonstration group (t = 36.40, p = 0.001) as this study shows that students learn more effectively
compared to the video‑assisted teaching program after the using demonstration methods. A quasi‑experimental study
intervention (t = 18.35, p = 0.001). conducted by Gowri et al.[19] to compare and evaluate the
effectiveness of web‑based and traditional instructional methods
Discussion to teach obstetrical palpation for antenatal mothers among
The study findings show that the posttest intervention B.Sc. nursing second‑year students revealed that skill on
scores were higher in the control group as compared obstetrical palpation was higher among students in the
with the experimental group indicating that traditional traditional group with a mean score of 27.87 (5.95) and
demonstration has more impact in improving the skill. The standard error of mean 1.53.
findings were consistent with a study of Karimi et al.,[17]
Based on the findings of the analysis, there was no
where total learning skills in the demonstration method was
statistically significant association of the posttest knowledge
more than in the video‑based method.
scores of subjects with their selected sociodemographic
The study findings also show that in the control group, variables such as age, type of residence, family monthly
the mean posttest skill score 55.13 (7.78) was higher than income, previous academic performance, and previous
the mean pretest skill score 1.20 (1.54). The calculated experience in taking care of antenatal women (p > 0.05).
paired t‑test value (36.40) was also statistically significant.
These findings are supported by Dash[18] who conducted These findings were supported by Midhula and
a randomized clinical trial with pre‑ and posttest designs to Balasubramanian[20] who conducted a pre‑experimental study
assess the effectiveness of the video‑assisted teaching to evaluate the video‑assisted teaching module on the
module on contraceptive methods in Pondicherry among care of dementia patients among B.Sc. nursing students at
977 couples. Dash’s study suggested that there was Mangalore. The result revealed that there was no
significant improvement in posttest knowledge, attitude, association between pretest skill and sociodemographic
and practice on contraceptive methods as compared with variables such as age, gender, academic performance, and
pretest and showed the effectiveness of the video‑assisted previous experience.
teaching program. A maternity nurse is an experienced and qualified
The study findings show that the mean posttest skill score specialist in providing essential support, advice, care, and
37.70 (10.47) was higher than the mean pretest skill score respite to parents and new‑born babies. Today, the publicis very
of 2.23 (1.97), which was found significant by paired t‑test much aware of their rights and the consumer protection act
value (18.35). The result indicates that there is a statistically that holds the maternity nurse accountable if any errors
are made during antepartum, intrapartum, and postpartum
Table 2: Comparison of pretest and posttest skill scores period. Hence, nurse educators can use a variety of
on obstetrical palpation in two groups teaching–learning methods and styles in clinical settings to
Skill scores Mean (SD) Independent teach a nursing procedure that suits the nature of the
t‑test students with the advancement in technology for
Control Experimental “t” p best adaptation by the younger generation nurses. The
group group nursing curricula should focus on the mixing of traditional
Pretest skill 1.20 (1.54) 2.23 (1.97) 0.41 >0.05 instruction method with the modern teaching methods
Posttest skill 55.13 (7.78) 37.70 (10.47) 3.66 <0.001 in clinical settings so that the students will benefit from
“t” 36.40 18.35 the blended learning. Hence, teachers can use different
Paired t‑test, <0.001 <0.001 teaching strategies to encourage critical thinking in
p=3.66 students.

Table 3: Comparison of pretest and posttest skill scores on subscales of obstetrical palpation between two groups
Area of skill Mean (SD) Independent t‑test
Control group Experimental group “t” p
Preparatory phase 50.75 (8.54) 39.10 (17.09) 1.03 >0.05
Abdominal palpation
Fundal palpation 52.25 (6.75) 43.50 (20.35) 0.58 >0.05
Lateral palpation 53.25 (6.39) 47 (2.82) 4.40 <0.001
First pelvic grip 37.12 (20.60) 22.30 (19.50) 0.90 >0.05
Second pelvic grip 32.30 (18) 8.16 (3.60) 6.55 <0.001
Auscultation of fetal heart sound 53.66 (2.08) 30.30 (10.26) 6.03 <0.001
Termination phase 43.50 (10.60) 34.25 (16.60) 0.832 >0.05

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Devi, et al.: Video‑ assisted teaching program and traditional demonstration on performing obstetrical palpation

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